Formative Assessment of ARM-U: A Modular Intervention for Decreasing Risk Behaviors Among HIV-Positive and HIV-Negative Methamphetamine-Using MSM

Abstract

Background: Methamphetamine is a major contributor to HIV transmission among men who have sex with men (MSM). Recent studies show that up to one-third of methamphetamine-using MSM (MUMSM) inject the drug. We developed a behavioral intervention for MUMSM to decrease unprotected anal intercourse and increase awareness of parenteral HIV transmission risk. This 6-session (3 in-person, 3 by telephone) modular intervention was designed to be tailored to participants' HIV (+/-) and injection drug user ([IDU] yes/no) status. We present results of formative research used to evaluate the content and to assess feasibility and acceptability of this individual-level HIV risk-reduction intervention.

Setting: HIV research clinic in a high MSM and methamphetamine prevalence neighborhood.

Project: Avoiding Risks from Methamphetamine-Use (ARM-U) is a brief toolbox intervention that allows counselors to select modules that suit a client's individual risk profile and intervention needs employing motivational interviewing and cognitive behavioral theory. We evaluated the format and content of the intervention through focus groups and pre-testing of the entire intervention using volunteers from the target population stratified into four groups (HIV+/IDU, HIV-/IDU, HIV+/non-IDU, HIV-/non-IDU). Four individuals in each stratum were recruited to undergo the intervention and complete a satisfaction survey at the end of each in-person session.

Results: In total, 25 MUMSM attended one of five focus groups. Participants thought all proposed intervention topics were important and could aid in reducing sexual risk behaviors among MUMSM. However, the neurocognitive effects of methamphetamine were reported to be a barrier to practicing safer sex, condom use negotiation or HIV status disclosure. Fifteen (94%) of 16 participants completed all 6 sessions and the satisfaction survey. On average, participants felt the intervention was useful for MUMSM, made them contemplate and move toward behavior change, and would recommend the program to their peers.

Lessons learned: Based on our formative research, we revised the ARM-U intervention to emphasize pre-planning to avoid combining methamphetamine use and sex or develop strategies to avoid sex risk following methamphetamine use. We also increased emphasis on referrals for care and other requested services. Future efficacy trials are needed to evaluate the intervention's ability to reduce HIV-associated risk behaviors.

Keywords: HIV; MSM; behavioral intervention.; formative research; injection drug use; methamphetamine.

Fig. (1)

Intervention session modules.

Fig. (2). Participant feedback on Sessions 1 and 4 of the ARM-U intervention.

For questions 4-10, on a scale from 1 (stongly disagree) to 10 (strongly agree), please indicate the level to which you agree with each of the following statements: Q4: Provided me w/information about protecting my health, which I intend to use Q5: Made me think about protecting my health in new ways Q6: Made me think about protecting my sex partners’ health in new ways Q7: I feel more motivated to protect my own and partners’ health now than before session Q8: I feel more capable of protecting my own and partners’ health now than before session Q9: The health counselor was knowledgeable about session topics Q10: The health counselor could easily relate to my situation and lifestyle

Fig. (3). Participant overall feedback on the ARM-U intervention.

For questions 9-16, on a scale from 1 (stongly disagree) to 10 (strongly agree), please indicate the level to which you agree with each of the following statements: Q9: Overall, I learned a lot form this program Q10: Overall, the program motivated me to think about my sexual behavior Q11: Overall, the program motivated me to think about my Meth use Q12: The program motivated me to make positive changes in my life Q13: I would recommend this program to other men like me Q14: The session health counselor was knowledgeable Q15: The session health counselor was supportive Q16: The session health counselor was respectful of me